Key result
Incomplete stent apposition in elliptical arteries elevates wall shear stress, increasing risk of in-stent thrombosis.
Why the study?
Previous research focused on incomplete stent apposition (ISA) in idealized circular arteries, but arterial cross section eccentricity influences the location and severity of ISA.
How does incomplete stent apposition in arteries with elliptical cross sections affect wall shear stress and shear rate?
How does incomplete stent apposition in arteries with elliptical cross sections affect wall shear stress and shear rate?
Computational modeling demonstrates that incomplete stent apposition in elliptical arteries creates adverse hemodynamic conditions, such as high proximal shear rate and low distal wall shear stress, which may serve as a nidus for in-stent thrombosis.
Elliptical malapposition may heighten thrombosis risk; challenges circular models and leaves open patient implications.
Incomplete stent apposition (ISA) is one of the causes leading to poststent complications, which can be found when an undersized or an underexpanded stent is deployed at lesions. The previous research efforts have focused on ISA in idealized coronary arterial geometry with circular cross section. However, arterial cross section eccentricity plays an important role in both location and severity of ISA. Computational fluid dynamics (CFD) simulations are carried out to systematically study the effects of ISA in arteries with elliptical cross section, as such stents are partially embedded on the minor axis sides of the ellipse and malapposed elsewhere. Overall, ISA leads to high time-averaged wall shear stress (TAWSS) at the proximal end of the stent and low TAWSS at the ISA transition region and the distal end. Shear rate depends on both malapposition distance and blood stream locations, which is found to be significantly higher at the inner stent surface than the outer surface. The proximal high shear rate signifies increasing possibility in platelet activation, when coupled with low TAWSS at the transition and distal regions which may indicate a nidus for in-stent thrombosis.
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Jiang et al. (2019) studied this question. Incomplete stent apposition in elliptical arteries leads to high wall shear stress at the proximal end, increasing the risk of platelet activation and potential in-stent thrombosis.
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